Care Coordination for Postacute Stroke, Chronic Obstructive Pulmonary Disease, and Heart Failure Clients: An Economic Rapid Review

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1 Care Coordination for Postacute Stroke, Chronic Obstructive Pulmonary Disease, and Heart Failure Clients: An Economic Rapid Review Health Quality Ontario February 2015 Economic Rapid Review. February 2015; pp. 1 20

2 Suggested Citation This report should be cited as follows: Health Quality Ontario. Care coordination for postacute stroke, chronic obstructive pulmonary disease, and heart failure clients: an economic rapid review. Toronto: Health Quality Ontario; 2015 February. 20 p. Available from: Permission Requests All inquiries regarding permission to reproduce any content in Health Quality Ontario reports should be directed to How to Obtain Rapid Reviews from Health Quality Ontario All rapid reviews are freely available in PDF format at the following URL: Conflict of Interest Statement All authors in the Evidence Development and Standards branch at Health Quality Ontario are impartial. There are no competing interests or conflicts of interest to declare. Rapid Review Methodology Rapid reviews must be completed in a 2- to 4-week time frame. Clinical questions are developed by the Evidence Development and Standards branch at Health Quality Ontario, in consultation with experts, end users, and/or applicants in the topic area. A systematic literature search is then conducted to identify relevant systematic reviews, health technology assessments, and meta-analyses. The methods prioritize systematic reviews, which, if found, are rated by AMSTAR to determine the methodological quality of the review. If the systematic review has evaluated the included primary studies using the GRADE Working Group criteria (http://www.gradeworkinggroup.org/index.htm), the results are reported and the rapid review process is complete. If the systematic review has not evaluated the primary studies using GRADE, the primary studies in the systematic review are retrieved and the GRADE criteria are applied to 2 outcomes. If no systematic review is found, then RCTs or observational studies are included, and their risk of bias is assessed. All rapid reviews are developed and finalized in consultation with experts. Economic Rapid Review. February 2015; pp

3 About Health Quality Ontario Health Quality Ontario is an arms-length agency of the Ontario government. It is a partner and leader in transforming Ontario s health care system so that it can deliver a better experience of care, better outcomes for Ontarians, and better value for money. Health Quality Ontario strives to promote health care that is supported by the best available scientific evidence. The Evidence Development and Standards branch works with expert advisory panels, clinical experts, scientific collaborators, and field evaluation partners to conduct evidence-based reviews that evaluate the effectiveness and cost-effectiveness of health interventions in Ontario. Based on the evidence provided by Evidence Development and Standards and its partners, the Ontario Health Technology Advisory Committee a standing advisory subcommittee of the Health Quality Ontario Board makes recommendations about the uptake, diffusion, distribution, or removal of health interventions to Ontario s Ministry of Health and Long-Term Care, clinicians, health system leaders, and policy-makers. Health Quality Ontario s research is published as part of the Ontario Health Technology Assessment Series, which is indexed in MEDLINE/PubMed, Excerpta Medica/Embase, and the Centre for Reviews and Dissemination database. Corresponding Ontario Health Technology Advisory Committee recommendations and other associated reports are also published on the Health Quality Ontario website. Visit for more information. About Health Quality Ontario Publications To conduct its rapid reviews, the Evidence Development and Standards branch and its research partners review the available scientific literature, making every effort to consider all relevant national and international research; collaborate with partners across relevant government branches; consult with expert advisory panels, clinical and other external experts, and developers of health technologies; and solicit any necessary supplemental information. In addition, Evidence Development and Standards collects and analyzes information about how a health intervention fits within current practice and existing treatment alternatives. Details about the diffusion of the intervention into current health care practices in Ontario add an important dimension to the review. Information concerning the health benefits, economic and human resources, and ethical, regulatory, social, and legal issues relating to the intervention may be included to assist in making timely and relevant decisions to optimize patient outcomes. Disclaimer This rapid review is the work of the Evidence Development and Standards branch at Health Quality Ontario, and is developed from analysis, interpretation, and comparison of published scientific research. It also incorporates, when available, Ontario data and information provided by experts. As this is a rapid review, it may not reflect all the available scientific research and is not intended as an exhaustive analysis. Health Quality Ontario assumes no responsibility for omissions or incomplete analysis resulting from its rapid reviews. In addition, it is possible that other relevant scientific findings may have been reported since completion of the review. This report is current as of the date of the literature search specified in the Research Methods section. Health Quality Ontario makes no representation that the literature search captured every publication that was or could be applicable to the subject matter of the report. This rapid review may be superseded by an updated publication on the same topic. Please check the Health Quality Ontario website for a list of all publications: Economic Rapid Review. February 2015; pp

4 Table of Contents List of Abbreviations... 5 Background... 6 Objective of Analysis... 7 Clinical Need and Target Population... 7 Rapid Review... 8 Research Question... 8 Research Methods... 8 Quality of the Economic Evidence... 9 Results of Rapid Review... 9 Limitations... 9 Conclusions Acknowledgements Appendices Appendix 1: Literature Search Strategies Appendix 2: Critical Appraisal of Studies Given Full-Text Review References Economic Rapid Review. February 2015; pp

5 List of Abbreviations ADL CCAC CHF COPD IQR NICE PGCMS QALY RCT RMI THETA Activities of daily living Community care access centre Congestive heart failure Chronic obstructive pulmonary disease Interquartile range National Institute for Health and Care Excellence Philadelphia Geriatric Center Morale Scale Quality-adjusted life-year Randomized controlled trial Rivermead Mobility Index Toronto Health Economics and Technology Assessment Collaborative Economic Rapid Review. February 2015; pp

6 Background The Programs for the Assessment of Technology in Health (PATH) Research Institute/Toronto Health Economics and Technology Assessment (THETA) Collaborative was commissioned by Health Quality Ontario to evaluate the costeffectiveness and predict the long-term costs and effects of a technique for disease. Published economic evaluations are reviewed, and the structure and inputs of the economic model used to estimate cost-effectiveness are summarized. The results of the economic analyses are presented for the technique versus comparator, and the budget impact of implementing each intervention is estimated. Health Quality Ontario conducts full evidence-based analyses, including economic analyses, of health technologies being considered for use in Ontario. These analyses are then presented to the Ontario Health Technology Advisory Committee, whose mandate is to examine proposed health technologies in the context of available evidence and existing clinical practice and to provide advice and recommendations to Ontario health care practitioners, the broader health care system, and the Ontario Ministry of Health and Long-Term Care. DISCLAIMER: Health Quality Ontario uses a standardized costing method for its economic analyses. The main cost categories and associated methods of retrieval from the province s perspective are described below. Hospital costs: Ontario Case Costing Initiative cost data are used for in-hospital stay, emergency department visit, and day procedure costs for the designated International Classification of Diseases diagnosis codes and Canadian Classification of Health Interventions procedure codes. Adjustments may be required to reflect accuracy in the estimated costs of the diagnoses and procedures under consideration. Due to difficulties in estimating indirect costs in hospitals associated with a particular diagnosis or procedure, Health Quality Ontario normally defaults to a consideration of direct treatment costs only. Non-hospital costs: These include physician services costs obtained from the Ontario Benefits for Physician Services, laboratory fees from the Ontario Schedule of Laboratory Fees, drug costs from the Ontario Drug Benefit Formulary, and device costs from the perspective of local health care institutions whenever possible, or from the device manufacturer. Discounting: For cost-effectiveness analyses, a discount rate of 5% is applied (to both costs and effects/qalys), as recommended by economic guidelines. Downstream costs: All reported downstream costs are based on assumptions of population trends (i.e., incidence, prevalence, and mortality rates), time horizon, resource utilization, patient compliance, health care patterns, market trends (i.e., rates of intervention uptake or trends in current programs in place in the province), and estimates of funding and prices. These may or may not be realized by the Ontario health care system or individual institutions and are often based on evidence from the medical literature, standard listing references, and educated hypotheses from expert panels. In cases where a deviation from this standard is used, an explanation is offered as to the reasons, the assumptions, and the revised approach. The economic analysis represents an estimate only, based on the assumptions and costing methods explicitly stated above. These estimates will change if different assumptions and costing methods are applied to the analysis. NOTE: Numbers may be rounded to the nearest decimal point, as they may be reported from an Excel spreadsheet. As legislated in Ontario s Excellent Care for All Act, Health Quality Ontario s mandate includes the provision of objective, evidence-informed advice about health care funding mechanisms, incentives, and opportunities to improve quality and efficiency in the health care system. As part of its Quality- Based Procedures (QBP) initiative, Health Quality Ontario works with multidisciplinary expert panels (composed of leading clinicians, scientists, and administrators) to develop evidence-based practice recommendations and define episodes of care for selected disease areas or procedures. Health Quality Ontario s recommendations are intended to inform the Ministry of Health and Long-Term Care s Health System Funding Strategy. For more information on Health Quality Ontario s Quality-Based Procedures initiative, visit Economic Rapid Review. February 2015; pp

7 Objective of Analysis The objective of this rapid review is to summarize the peer-reviewed literature on the cost-effectiveness of care coordination for post-acute stroke, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) patients. Clinical Need and Target Population A case manager is defined as a health care worker who assesses a patient s needs and develops a care plan for home care services, coordinates home care provision, and guides the patient through the health and social support systems. Care coordination plays an important role in enabling community care access centres (CCACs) to fulfil their mandate of providing home care and managing the process of placing clients in long-term care facilities. More specifically, the case manager is responsible for assessing clients needs for home care services and determining their eligibility; developing a care plan for each client; coordinating care provision; reassessing need, as necessary; supporting the client through social and health support systems; and discharging the client from home care. (1) Working at the client level, care coordination is expected to provide people with timely and appropriate home care services in an environment with limited health care resources. With the aid of case managers, people should receive the care they need, resulting in improved health outcomes and efficient use of home care services. (1) However, care coordination does come at a cost: CCACs must hire and train case managers. The cost-effectiveness of care coordination is unknown. Thus, this economic rapid review was conducted to briefly search for economic evidence on care coordination. Economic Rapid Review. February 2015; pp

8 Rapid Review Research Question What is the cost effectiveness of care by a case manager for post-acute patients with stroke, congestive heart failure, or chronic obstructive pulmonary disease? The effectiveness can be measured per qualityadjusted life year or per clinical outcome. Research Methods Literature Search Literature searches were performed on January 20 and 22, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, and Wiley Cochrane Library databases, including NHS Economic Evaluation Database, for studies published from January 1, 2009, to January 21, The search terms were identical to those in the search conducted for the clinical evidence rapid review on the same subject, with additional limits to restrict results to economics-related studies. (Appendix 1 provides details of the search strategies.) As well, given the smaller number of relevant economic articles anticipated, the economic rapid review included observational studies. Titles and abstracts were reviewed by a single reviewer and, for those studies potentially meeting the eligibility criteria, full-text articles were obtained and reviewed. Reference lists were also examined for any additional relevant studies not identified through the search. Inclusion Criteria English-language full-text publications published between January 1, 2009 and January 21, 2014 Exclusion Criteria post-acute adult patients with stroke, COPD, or CHF care coordination intervention letters, editorials, historical articles Outcomes of Interest costs quality-adjusted life-years (QALYs) clinical outcomes Economic Rapid Review. February 2015; pp

9 Expert Panel In November 2013, an Expert Advisory Panel on Post-Acute Community-Based Care for Stroke Patients was struck. Members of the panel included physicians, nurses, allied health professionals, and personnel from the Ministry of Health and Long-Term Care. The role of the expert advisory panel was to provide advice on primary stroke patient groupings; to review the evidence, guidance, and publications related to defined stroke patient populations; to identify and prioritize interventions and areas of community-based care; to advise on the development of a care pathway model; and to develop recommendations to inform funding mechanisms. The role of panel members was to provide advice on the scope of the project, the methods used, and the findings. However, the statements, conclusions, and views expressed in this report do not necessarily represent the views of the expert panel members. Quality of the Economic Evidence To determine the usefulness of each identified study for decision-making, we applied a modified version of a methodology checklist for economic evaluations, developed by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. (2) The original checklist was used to inform the development of clinical guidelines by NICE; the wording of the questions was modified to remove references to guidelines and to make it Ontario specific. A summary of the number of studies judged to be directly applicable, partially applicable, and not applicable to the research question is presented in Appendix 2. Results of Rapid Review A total of 1,514 articles published from January 1, 2009 to January 21, 2014 were identified by Ovid MEDLINE. The Cochrane databases found 279 publications from the same period. All titles and abstracts were reviewed. After an initial review, a total of 1,783 abstracts were excluded and the full text of the remaining 10 papers were reviewed (Appendix 2). Upon critical appraisal of the full text articles, no studies met the criteria for inclusion. Two of the studies did not have the appropriate study population (a chronic disease population was explored, but results for the diseases of interest stroke, COPD, and CHF were not stratified). Seven studies did not have the appropriate intervention, with 5 studies investigating a patient education program, 1 study exploring the provision of hospital services in a home setting, and 1 study on transitional care provision. In the 1 remaining study, neither the population nor the intervention were appropriate for our review. Since no studies were applicable, the level of limitations was not assessed. Limitations The results of this economic rapid review are limited because, due to the time restrictions established in the rapid review methodology, the literature search was limited to a 5-year timeframe. Thus, the review did not consider publications from before Economic Rapid Review. February 2015; pp

10 Conclusions No studies were identified that examined the cost-effectiveness of care by a case manager for post-acute patients with stroke, congestive heart failure, or chronic obstructive pulmonary disease. Therefore, the cost-effectiveness is unclear. Economic Rapid Review. February 2015; pp

11 Acknowledgements Editorial Staff Sue MacLeod, BA Medical Information Services Corinne Holubowich, BEd, MLIS Kellee Kaulback, BA(H), HISt Joanna Bielecki, BSc, MISt (THETA) Health Quality Ontario s Expert Advisory Panel on Post-Acute, Community-Based Care for Stroke Patients Name Affiliation(s) Appointment(s) Panel Co-Chairs Dr Mark Bayley Karyn Lumsden Neurology Dr Leanne Casaubon Toronto Rehabilitation Institute; University of Toronto Central West Community Care Access Centre (CCAC) Toronto Western Hospital; University of Toronto Medical Director of the Neuro-rehabilitation Program; Associate Professor Vice President of Client Services Assistant Professor-Division of Neurology, Stroke Program Physical Medicine and Rehabilitation Dr Robert Teasell Stroke Rehabilitation Program at Parkwood Hospital; Western University Medical Director; Professor Family Medicine Dr Adam Stacy Ontario Medical Association Board Member Nursing Connie McCallum Niagara Health System Nurse Practitioner, TIA/Stroke Prevention Clinic Trixie Williams Central East LHIN Lead, Vascular Health Arms Armesto Sunnybrook Health Sciences Centre Clinical Nurse Specialist Karen Sutherland Occupational Therapy David Ure Rebecca Fleck St. Joseph s Health Care London Parkwood Hospital Parkwood Hospital Hamilton Health Sciences Centre Service Lead, Specialized Community Stroke Rehabilitation Team Coordinator, Community Stroke Rehabilitation Team Regional Stroke Educator and Research Coordinator Economic Rapid Review. February 2015; pp

12 Name Affiliation(s) Appointment(s) Physiotherapy Sara McEwen Stefan Pagliuso Speech/Language Pathology Sunnybrook Research Institute, St. John's Rehab Hamilton Health Sciences Centre Research Scientist Regional Stroke Rehabilitation, Community and LTC Coordinator Holly Sloan Trillium Health Centre Speech/Language Pathologist Social Work Joanne Avery Administration Providence Healthcare, Out-patient Stroke Clinic Social Worker Christina O'Callaghan Ontario Stroke Network (OSN) Executive Director Jim Lumsden Paula Gilmore The Ottawa Hospital, LHIN-Champlain Regional Stroke Program London Health Sciences Centre, Southwestern Ontario Stroke Strategy Director Community and Long Term Care Coordinator Mathew Meyer Ontario Stroke Network (OSN) Project Coordinator Joan Southam Patient Representation CBI-LHIN Home Health Senior Manager and Project Specialist Daniel Brouillard Kingston Heart Clinic Internist, Stroke Survivor Nicole Martyn-Capobianco University of Guelph-Humber Program Head of Human Services Economic Rapid Review. February 2015; pp

13 Appendices Appendix 1: Literature Search Strategies Search date: January, 20, 2014 Databases searched: OVID MEDLINE 1946 to January Week , MEDLINE In-Process and Other Non-Indexed Citations January 20, 2014 Limits: English language, not letter, editorial or historical article, 2009-current Filters: Economic evaluation filter # Searches Results 1 exp Patient Discharge/ or exp Aftercare/ or exp Convalescence/ or "Continuity of Patient Care"/ or exp "Recovery of Function"/ or ((patient* adj2 discharge*) or after?care or post medical discharge* or post?discharge* or convalescen*).ti,ab. 2 exp Stroke/ or exp brain ischemia/ or exp intracranial hemorrhages/ or (stroke or poststroke or tia or transient ischemic attack or ((cerebral vascular or cerebrovascular) adj (accident* or infarct*)) or CVA or cerebrovascular apoplexy or brain infarct* or (brain adj2 isch?emia) or (cerebral adj2 isch?emia) or (intracranial adj2 h?emorrhag*) or (brain adj2 h?emorrhag*)).ti,ab. 3 exp Heart Failure/ or (((cardia? or heart) adj (decompensation or failure or incompetence or insufficiency)) or cardiac stand still or ((coronary or myocardial) adj (failure or insufficiency))).ti,ab. 4 exp Pulmonary Disease, Chronic Obstructive/ or exp Emphysema/ or (copd or coad or chronic airflow obstruction* or (chronic adj2 bronchitis) or emphysema or (chronic obstructive adj2 (lung* or pulmonary or airway* or airflow* or respiratory or bronchopulmonary) adj (disease* or disorder*))).ti,ab. 5 exp Pneumonia/ or (pneumoni* or peripneumoni* or pleuropneumoni* or lobitis or ((pulmon* or lung*) adj inflammation*)).ti,ab. 6 or/ exp Caregivers/ or exp Case Management/ or exp Patient Care Management/ or exp Social Support/ or exp Counseling/ or exp Patient Education as Topic/ or (liaison* or case manage* or care manage* or counsel* or healthcare worker* or health-care worker*).ti,ab. 8 economics/ or exp "costs and cost analysis"/ or economics, dental/ or exp "economics, hospital"/ or economics, medical/ or economics, nursing/ or economics, pharmaceutical/ or (economic$ or cost or costs or costly or costing or price or prices or pricing or pharmacoeconomic$ or (expenditure$ not energy) or (value adj1 money) or budget$).ti,ab. 9 (((energy or oxygen) adj cost) or (metabolic adj cost) or ((energy or oxygen) adj expenditure)).ti,ab not (letter or editorial or historical article).pt not Animals/ not (Animals/ and Humans/) not and 7 and limit 15 to english language limit 16 to yr="2009 -Current" 1514 Economic Rapid Review. February 2015; pp

14 Search date: January 22, 2014 Databases searched: Cochrane Library Databases (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Database of Abstracts of Reviews of Effects, Health Technology Assessment, NHS Economic Evaluation Database) Limits: English language, not letter, editorial or historical article Filters: Economic evaluation filter ID Search Hits 1 MeSH descriptor: [Patient Discharge] explode all trees MeSH descriptor: [Aftercare] explode all trees MeSH descriptor: [Convalescence] explode all trees MeSH descriptor: [Continuity of Patient Care] explode all trees MeSH descriptor: [Recovery of Function] explode all trees ((patient* adj2 discharge*) or after?care or post medical discharge* or post?discharge* or 938 convalescen*):ti,ab,kw 7 #1 or #2 or #3 or #4 or #5 or # MeSH descriptor: [Stroke] explode all trees MeSH descriptor: [Brain Ischemia] explode all trees MeSH descriptor: [Intracranial Hemorrhages] explode all trees stroke or tia or transient ischemic attack or cerebrovascular apoplexy or cerebrovascular accident or cerebrovascular infarct* or brain infarct* or CVA or (brain adj2 isch?emia) or (cerebral adj2 isch?emia) or (intracranial adj2 hemorrhag*) or (brain adj2 hemorrhag*):ti,ab,kw (Word variations have been searched) 12 #8 or #9 or #10 or # MeSH descriptor: [Heart Failure] explode all trees (((cardia? or heart) adj (decompensation or failure or incompetence or insufficiency)) or cardiac 9 stand still or ((coronary or myocardial) adj (failure or insufficiency))):ti,ab,kw 15 #13 or # MeSH descriptor: [Pulmonary Disease, Chronic Obstructive] explode all trees MeSH descriptor: [Emphysema] explode all trees ((copd or coad or chronic airflow obstruction* or (chronic adj2 bronchitis) or emphysema) or 7007 (chronic obstructive adj2 (lung* or pulmonary or airway* or airflow* or respiratory or bronchopulmonary) adj (disease* or disorder*))):ti,ab,kw 19 #16 or #17 or # MeSH descriptor: [Pneumonia] explode all trees (pneumoni* or peripneumoni* or pleuropneumoni* or lobitis or ((pulmon* or lung*) adj 6064 inflammation*)):ti,ab,kw 22 #20 or # #7 or #12 or #15 or #19 or # MeSH descriptor: [Caregivers] explode all trees MeSH descriptor: [Case Management] explode all trees MeSH descriptor: [Patient Care Management] explode all trees MeSH descriptor: [Social Support] explode all trees MeSH descriptor: [Counseling] explode all trees MeSH descriptor: [Patient Education as Topic] explode all trees (liaison* or case manage* or care manage* or counsel* or healthcare worker* or health-care worker*):ti,ab,kw 31 #24 or #25 or #26 or #27 or #28 or #29 or # MeSH descriptor: [Economics] this term only MeSH descriptor: [Costs and Cost Analysis] explode all trees MeSH descriptor: [Economics, Dental] this term only 3 35 MeSH descriptor: [Economics, Hospital] explode all trees MeSH descriptor: [Economics, Medical] this term only 36 Economic Rapid Review. February 2015; pp

15 37 MeSH descriptor: [Economics, Nursing] this term only MeSH descriptor: [Economics, Pharmaceutical] this term only (economic* or cost or costs or costly or costing or price or prices or pricing or pharmacoeconomic*) or (expenditure* not energy) or (value near/1 money) or budget*:ti,ab,kw (Word variations have been searched) 40 #32 or #33 or #34 or #35 or #36 or #37 or #38 or # ((energy or oxygen) near cost) or (metabolic near cost) or ((energy or oxygen) near 2010 expenditure):ti,ab,kw (Word variations have been searched) 42 #40 not # letter or editorial or historical article:pt (Word variations have been searched) #42 not # MeSH descriptor: [Animals] explode all trees MeSH descriptor: [Humans] explode all trees #45 not (#45 and #46) #44 not # #23 and #31 and #48 from 2009 to Economic Rapid Review. February 2015; pp

16 Appendix 2: Critical Appraisal of Studies Given Full-Text Review Question topic: To assess the cost-effectiveness of case management for post-acute stroke, chronic obstructive pulmonary disease, and congestive heart failure patients. Author/Year Is the study population appropriate to the question? Are the interventions appropriate to the question? Agren et al, 2013 (3) Yes No No Bakerly et al, 2009 (4) Yes No No Dewan et al, 2011 (5) Yes No No Glendenning-Napoli et al, No Yes Yes 2012 (6) Harrington et al, 2010 (7) Yes No No Miller et al, 2009 (8) Yes No No Peikes et al, 2009 (9) No Yes Yes Postmus et al, 2011 (10) Yes No No Saleh et al, 2012 (11) No No No Stauffer et al, 2011 (12) Yes No No What country was this study conducted in? Is the health care system in which the study was conducted sufficiently similar to Ontario s with respect to this question/topic? Explain the ways in which they differ. Agren et al, 2013 (3) Sweden Yes No Bakerly et al, 2009 (4) UK Yes No Dewan et al, 2011 (5) US No US Veterans Affairs No Glendenning-Napoli et al, US No NA 2012 (6) Harrington et al, 2010 (7) UK Yes No Miller et al, 2009 (8) US No No Peikes et al, 2009 (9) US No No Postmus et al, 2011 (10) Netherlands Yes Yes Saleh et al, 2012 (11) US No No Stauffer et al, 2011 (12) US No No Are all relevant interventions compared? Are estimates of relative treatment effect the same as those included in the review? Economic Rapid Review. February 2015; pp

17 Are costs measured from a health care payer perspective? Are non-direct health effects on individuals excluded? Agren et al, 2013 (3) Yes No NA Bakerly et al, 2009 (4) Yes No NA Dewan et al, 2011 (5) Yes No NA Glendenning-Napoli et al, No No No 2012 (6) Harrington et al, 2010 (7) Yes No No Miller et al, 2009 (8) Yes No No Peikes et al, 2009 (9) Yes No NA Postmus et al, 2011 (10) Yes No No Saleh et al, 2012 (11) Yes No No Stauffer et al, 2011 (12) Yes No No Do the estimates of resource use differ from that which would be expected in an Ontario context? Is the value of health expressed in terms of QALYs? Agren et al, 2013 (3) No Yes NA Bakerly et al, 2009 (4) No NA NA Dewan et al, 2011 (5) Unclear NA NA Glendenning-Napoli et al, Yes NA NA 2012 (6) Harrington et al, 2010 (7) No No Yes Miller et al, 2009 (8) Yes Yes Yes Peikes et al, 2009 (9) Yes No No Postmus et al, 2011 (10) No Yes Yes Saleh et al, 2012 (11) Yes No No Stauffer et al, 2011 (12) No No No Are both costs and health effects discounted at an annual rate of 5%? Are changes in healthrelated quality of life (HRQL) obtained directly from patients and/or carers? Economic Rapid Review. February 2015; pp

18 Was the valuation of changes in HRQL (utilities) obtained from a representative sample of the general public? Overall judgement (directly applicable/partially applicable/not applicable) Other comments Agren et al, 2013 (3) No Not applicable Intervention (nurse-led education) was not appropriate. Bakerly et al, 2009 (4) NA Not applicable Intervention (hospital services at home) was not appropriate. Dewan et al, 2011 (5) NA Not applicable Intervention (disease management through education by case manager) was not appropriate. Glendenning-Napoli et al, 2012 (6) Harrington et al, 2010 (7) NA Not applicable Chronic disease population was not stratified to the disease of interest. No Not applicable Intervention (exercise and education program) was not appropriate. Miller et al, 2009 (8) No Not applicable Intervention (education and medication management) was not appropriate. Peikes et al, 2009 (9) No Not applicable Chronic disease population was not stratified to the diseases of interest. Postmus et al, 2011 (10) No Not applicable Intervention (nurse-led disease management) was not appropriate. Saleh et al, 2012 (11) No Not applicable Neither intervention (care coordination without linkage to health care services) nor population (elderly Medicare recipients) were appropriate. Stauffer et al, 2011 (12) No Not applicable Intervention (transitional care provision) was not appropriate. Abbreviations: HRQL, health-related quality of life; NA, not applicable; QALY, quality-adjusted life-year. Economic Rapid Review. February 2015; pp

19 References (1) Ontario Ministry of Health and Long-Term Care. Community Care Access Centres Client Services Policy Manual [Internet]. Toronto, ON: Ontario Ministry of Health and Long-Term Care; 2006 Sep [Cited: 2014 Sep 15]. 17 p. Available from: (2) National Institute for Health and Care Excellence. Process and methods guides. The guidelines manual: Appendix G: Methodology checklist: economic evaluations [Internet]. United Kingdom: National Institute for Health and Care Excellence; 2012 Nov [Cited: 2014 Sep 16]. 1 p. Available from: (3) Agren S, Evangelista L, Davidson T, Stromberg A. Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners (Provisional abstract). JCN. 2013;22: (4) Bakerly ND, Davies C, Dyer M, Dhillon P. Cost analysis of an integrated care model in the management of acute exacerbations of chronic obstructive pulmonary disease. Chron Respir Dis. 2009;6(4): (5) Dewan NA, Rice KL, Caldwell M, Hilleman DE. Economic evaluation of a disease management program for chronic obstructive pulmonary disease. COPD. 2011;8(3): (6) Glendenning-Napoli A, Dowling B, Pulvino J, Baillargeon G, Raimer BG. Community-based case management for uninsured patients with chronic diseases: effects on acute care utilization and costs. Prof Case Manag. 2012;17(6): (7) Harrington R, Taylor G, Hollinghurst S, Reed M, Kay H, Wood VA. A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation (Structured abstract). Clin Rehabil. 2010;24:3-15. (8) Miller G, Randolph S, Forkner E, Smith B, Galbreath AD. Long-term cost-effectiveness of disease management in systolic heart failure. Med Decis Making. 2009;29(3): (9) Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009;301(6): (10) Postmus D, Pari AA, Jaarsma T, Luttik ML, van Veldhuisen DJ, Hillege HL, et al. A trial-based economic evaluation of 2 nurse-led disease management programs in heart failure. Am Heart J. 2011;162(6): (11) Saleh SS, Freire C, Morris-Dickinson G, Shannon T. An effectiveness and cost-benefit analysis of a hospital-based discharge transition program for elderly Medicare recipients. J Am Geriatr Soc. 2012;60(6): (12) Stauffer BD, Fullerton C, Fleming N, Ogola G, Herrin J, Stafford PM, et al. Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls. Arch Intern Med. 2011;171(14): Economic Rapid Review. February 2015; pp

20 Health Quality Ontario 130 Bloor Street West, 10 th Floor Toronto, Ontario M5S 1N5 Tel: Toll Free: Fax: Queen s Printer for Ontario, 2015 Economic Rapid Review. February 2015; pp

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